Melancholia is one of the great words of psychiatry. Suffering many mutations, at one time the tenacious guardian of outworn schemes or errant theories; presently misused, cavilled at, dispossessed, it has endured into our own times, a part of medical terminology no less than of common speech. It would seem profitable to consider the history of this word, and of the states of fear and distress with which it has from the beginning been associated.

Pregnancy, with the associated pain and danger of labour and the Puerperium, is an ordeal for any woman, more so perhaps to-day than it has ever been, because of the wide publicity given to the toll of puerperal infection and the need for ante-natal care. An experience so intimately connected with the love-life, and with social and economic difficulties also, is often a period of acute mental stress in perfectly healthy women. Still more is it a time of psychological tension in those constitutionally unstable and liable to mental breakdown, both because they are not able to withstand the strain of mental conflict, and because they are the more likely to meet with such emotional problems on account of their temperamental unbalance.

It has generally been considered by obstetricians and psychiatrists that the insanity of pregnancy, in common with other forms of insanity associated with the reproductive function, offers a favourable prognosis from the point of view of complete mental recovery of the mother. This standard view is to be found in most text-books on midwifery and mental diseases.

Female homicides can be conveniently considered under three headings: (i) Those who kill their children, (2) those who kill adults, and (3) abortionists. The last group has not been included in the 126 cases under review, because the mental condition of the abortionists is of little interest for our present purpose. I have never known a prisoner charged with this offence raise the subject in mitigation of punishment. The 126 cases are not in any way selected, but are the total number of murder charges I have had under my care at Holloway prison during the years 1923 to 1932, excluding cases of abortion. I have selected the year 1923 because the Legislature introduced the Infanticide Act in the previous year; this Act effected certain changes in practice to which I shall refer again in some detail.

The investigations herein set forth have been chiefly confined to the mobile tissue of the body, the blood. It is manifest that in abnormal biochemical changes affecting the organism in whole or part, this medium will be the locus, where such changes might reasonably present themselves and be detected by the means at our command. The substances therefore with which I shall be dealing are all normally present in the blood to a greater or less degree, but show marked variations under the stress of a mental breakdown. In particular I shall concentrate on lecithin, one of the phospholipins, cholesterol, belonging to the sterol group, and choline, which is classed with the animal bases.

Cholesterol metabolism in epilepsy has been investigated by a number of observers during recent years, but the results have been contradictory and confusing, as the following summary shows: 1920, De Crinis (1): Cholesterol increased before seizures. 1923, Pezzali (2): Cholesterol decreased before seizures; low average levels in epileptics. 1927, Robinson, Brain and Kay (3): Cholesterol decreased before seizures. 1927, Osnato and Killian (4): Results negative. 1929, Goodall (5): Results negative. 1929, Fox Gosden and Brain (6): Cholesterol decreased before seizures; general low values in epileptics and increased variability in individual patients. 1930, Duncan (7): That there is no definite evidence to show that the occurrence of an epileptic fit is associated with a fall in the level of cholesterol in the blood.

The object of this investigation was to ascertain the value of the bicoloured guaiac reaction on the cerebro-spinal fluid in mental hospital practice. The reaction, which was first described by de Thurzo (i), is similar in principle to the Lange gold sol test, in that under certain conditions precipitation occurs from a colloidal system. Its originality depends on the fact that two dyes, naphthol green and brilliant fuchsin are contained in the system, one of which attaches itself to the precipitating colloid (brilliant fuchsin), whilst the other (naphthol green) remains in the supernatant fluid. It is claimed that it is not so susceptible to possible fallacies as the gold sol test (such as chemical uncleanliness), that it is possibly more selective in its action, and that it has the same practical value in the laboratory diagnosis of neuro-syphilis. Results have been reported on hospital cases (2) showing fair agreement with the Lange and Wassermann tests, but so far no records are available showing the value of this test in a series of neuro-syphilitic cases from mental hospitals, with the exception of a brief report on 10 cases (3). The present report deals with 325 fluids obtained from cases in L.C.C. mental hospitals, and these included 125 cases of general paralysis treated by malaria and other pyrexial therapies.

The study of miniature hallucinations has been, in the main, the work of French psychiatrists, notably M. Leroy, who gave them the name “Lilliputian Hallucinations” (1), (2), (3), (4). A communication from M. Leroy on this subject was read at the Spring Meeting of the S.E. Division of the Medico-Psychological Association in 1922, and a report on this was published in the Journal of Mental Science (5).

In the literature on neurological complications of alcoholism but scant reference has been made to the occurrence of cranial nerve palsies in alcoholic peripheral neuritis. Although Russell Brain (1) states that there is no form of polyneuritis in which the cranial nerves may not suffer, he refers to the rarity with which they are affected in the alcoholic form, and mentions only the vagus and the facial nerves as being occasionally involved. Collier and Adie (2) in Price's Text-book of Medicine state that facial palsies, ptosis, nystagmus and weakness of the extra-ocular muscles have been observed, whilst Feiling (3) writes in the Oxford Medicine that with the exception of nystagmus, involvement of the cranial nerves is very rare in alcoholic neuritis.